Over the past few years, there has been a paradigm shift regarding how acute care can be delivered. The pandemic has accelerated the growth of nontraditional models of care, including acute, post-acute and ambulatory home-based care. In the traditional model, patients come to the site of care, but in a hospital at home setting, clinical services are brought to the patient’s home.

Despite industry interest, following CMS' acute care at home waiver launched in Nov 2020, the concept of hospital at home has been around for two decades. While the initial uptake was slow, today there are 204 unique hospitals who have received the CMS waiver. 

Virtua Health is one system that has developed a hospital at home program with the support of the Chartis Group. In building this program, Virtua Health had to identify critical steps in the patient journey within Home Hospital. They needed to decide how to operationalize patient identification, home set-up, care delivery and post-discharge transition. 

“We need to create an ecosystem of services … We have to decide what we can do in house and what we have to outsource.” He also noted the need to work with vendor partners and third parties that need to meet certain service-level requirements," Michael Capriotti, SVP of integration and strategic operations for Virtua Health, said during the panel.

When discussing the integration of new technology, Capriotti said, “We are going to start human-mediated, but partnering together and creating a road map with IT at the table … [will be crucial] to moving a program from human-mediated to more technology-mediated.”

Bringing acute-level care into the home presents a lot of challenges but also a lot of opportunities. One of the greatest values offered by hospital at home lies in its potential to create inpatient bed capacity. It has also been shown to be associated with shorter length of stay and lower resource utilization, opening up space for higher acuity cases.

One of the greatest challenges of the model is that it requires significant patient volume to achieve sufficient scale to support the program's underlying fixed costs. This can be limited by varying reimbursement models for acute home care, staffing constraints and appropriate resource allocation.

As hospital at home grows, the model will continue to evolve to meet the needs of its stakeholders, from patient to provider to health systems. Change management is a continuous process and will require adaptability and patience to improve.

"You have to have a leadership team that won’t panic … They have to be creative and comfortable in the gray [area] … and that’s not for everybody. Having those characteristics is crucial to getting a program launched and successful," Capriotti said.